Gastric bypass surgery can improve psychiatric behaviours

Bariatric surgery can results in improvements in patients’ psychiatric behaviours such as eating behaviours, mood disorders and body image, although the mechanism as to why is not clear, according to a study by Portuguese researchers. Published in the Archives of Clinical Psychiatry (São Paulo), the paper ‘A psychiatric perspective view of bariatric surgery patients’, states that despite these improvements clinicians should be aware that a risk of suicide and substance abuse (especially alcohol) after gastric bypass surgery remain in some patients.

“In order to create clinical guidelines to ameliorate bariatric surgery follow-up and facilitate the early diagnosis of eating disorders after surgery.”

The authors note that psychiatric problems are common among morbidly obese patients with several studies reporting a higher prevalence of psychiatric disorders in patients seeking bariatric surgery compared with the general population. Additional studies have again noted a higher prevalence of bariatric patients presenting with mood disorders, anxiety disorders, somatiation, hypochondria, obsessive compulsive disorders, binge eating behaviours and binge eating disorder (BED). Nevertheless, a considerable number of studies have demonstrated that weight loss and metabolic improvement as a result of bariatric surgery has also resulted in an overall improvement in mental health and psychosocial factors, the authors write.

In addition, the evidence that surgery can result in the alleviation of psychological, psychosocial and psychiatric status is demonstrated through greater patient optimism, higher self-esteem and patients taking a more active role in life, they note.

However, they report that is not seen in all studies and some of these benefits seem to be limited to the first years following weight loss surgery. Moreover, the presence of a postoperative psychiatric disorder can predict a lower probability of achieving a good outcome.

The authors reviewed all relevant literature via the PubMed database from January of 2002 to June of 2015. In total 75 articles were included from the research with additional articles included from the references list from relevant articles.

Eating behaviour

They report that a majority of the studies noted an improvement in eating behaviour after bariatric surgery (smaller amount of food eaten, a decrease in hunger, an earlier satiety, less inadequate eating behaviours and more control over patient food intake). But when patients have binge eating behaviours postoperatively, it is associated with reduced mental health and poor weight outcome.

Overall, they write that the postoperative results are inconsistent and therefore recommend long-term research and standardising the evaluation and diagnosis of eating behaviour “in order to create clinical guidelines to ameliorate bariatric surgery follow-up and facilitate the early diagnosis of eating disorders after surgery.”

Mood disorders

They report that most studies reported a decrease in depression and depressive symptoms after bariatric surgery, with females demonstrating a more marked decline than men. Again, there were no consistent results from the studies under review with some reporting significantly reduced levels of depression symptoms one, two and ten years after bariatric surgery, but others indicating an initial improvement in the first years postoperatively followed by the reappearance or worsening of depressive symptoms (associated with weight regain or weight stabilization)

Furthermore, a significant long-term relationship has been reported between depression and greater weight loss but not for anxiety symptomology. Again, some studies reported that bariatric patients may achieve normal scores of depression and anxiety following bariatric surgery.

“These inconsistent results may imply the presence of confounding factors. A prior trauma has been suggested as a possible candidate. Bariatric patients with traumatic background may present psychiatric complaints that are not fundamentally weight-related. Thus, traumatic histories might mediate the relationship between poorer postoperative weight loss and the maintenance of psychiatric symptoms,” they write.

They add patients’ expectations after surgery that may have a negative impact if the expected results are not obtained. Moreover, psychiatric medication may be a confounding influence on patient’s mood/anxiety post-surgery and they suggest that clinicians should attempt to place patients on weight-neutral medications, avoiding medication such a tricyclic antidepressants or mirtazapine (which are known to cause weight gain).

“For these reasons, postoperative monitoring of patients taking psychopharmacological medication is recommended. More knowledge needs to be acquired in the area of psychotropic medication pharmacokinetics in order to create clinical practice directives for the best care of bariatric patients.”

Body image

More females report body image dissatisfaction and is associated with higher incidence of depression and low self-esteem. Several studies showed that body image impairment, attractiveness and lack of familiarity with the body improved after surgery, although most studies have only investigated changes in the first and second year after surgery.

Residual body image dissatisfaction due to increasing and/or sagging skin has been reported following surgery and one study noted a correlation between the amount of excess skin and the degree of body image discomfort of bariatric patients.

The authors recommend that bariatric surgeons should counsel patients prior to surgery in order to prevent the psychological distress caused.

Suicide

The authors report that several studies have found that severely obese people may have an increased mortality by suicide and an increase of suicides in the surgical patients. However, they acknowledge that there is a significant variation in the characteristics of the studies and length of follow-up. Therefore, it is difficult to establish corrective comparisons between patients after bariatric surgery and the general population.

Substance use

Interestingly, some studies have reported that post-operative patients noticed that they become more intoxicated after consuming less alcohol and that there is a more rapid onset of intoxication effects comparing to the preoperative period. It is thought that RYGB limits the first step of metabolism and, consequently, higher serum levels of ethanol are obtained.

With regards to opioid use following bariatric surgery, some studies have suggested that the amount of opioid substance was greater postoperatively than preoperatively. One possible explanation is that obese individuals demonstrate more pain sensitivity and lower pain detection thresholds than those who are not obese and altered pain processing persists after bariatric surgery. Opioid consumption after surgery is greater among patients who are younger, men, and have been previously hospitalised because of psychiatric disorders.

“More studies evaluating substance abuse postoperatively are necessary to assist in the understanding of this area,” they note.

Conclusion

“Psychiatric disorders such as depressive, anxiety and binge eating disorders are prevalent among bariatric surgery candidates and an overall improvement in this psychopathology is observed after bariatric surgery,” they conclude. “Further research is warranted for a more complete understanding of psychopatological areas in bariatric surgery patients. Furthermore, long-term studies are needed to elucidate the decline in improvements with time that is reported in some studies. This knowledge will allow a better preoperative selection, but above all, a more efficient follow-up.”

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‘Love Your Body’ to Lose Weight

Almost a quarter of men and women in England and over a third of adults in America are obese. (In South Africa statistics on the percentage of overweight and obese people indicate that obesity and its co-morbidities are on the increase, with Cape Town leading the way!) Obesity increases the risk of diabetes and heart disease and can significantly shorten a person's life expectancy. New research published by BioMed Central's open access journal International Journal of Behavioral Nutrition and Physical Activity shows that improving body image can enhance the effectiveness of weight loss programs based on diet and exercise.

Researchers from the Technical University of Lisbon and Bangor University enrolled overweight and obese women on a year-long weight loss program. Half the women were given general health information about good nutrition, stress management, and the importance of looking after yourself. The other half attended 30 weekly group sessions (the intervention plan) where issues such as exercise, emotional eating, improving body image and the recognition of, and how to overcome, personal barriers to weight loss and lapses from the diet were discussed. On the behavioral intervention plan women found that the way they thought about their body improved and that concerns about body shape and size were reduced. Compared to the control group they were better able to self-regulate their eating and they lost much more weight, losing on average 7% of their starting weight compared to less than 2% for the control group. Dr Teixeira from Technical University of Lisbon, who led the research, said, "Body image problems are very common amongst overweight and obese people, often leading to comfort eating and more rigid eating patterns, and are obstacles to losing weight. Our results showed a strong correlation between improvements in body image, especially in reducing anxiety about other peoples' opinions, and positive changes in eating behavior. From this we believe that learning to relate to your body in healthier ways is an important aspect of maintaining weight loss and should be addressed in every weight control program."

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Also known as bariatric surgery, weight loss surgery constitutes a number of procedures all with one goal in mind being weight loss for the patient suffering from obesity. Along with this primary goal, other effects from such procedures are an improvement in cardiovascular functions and decrease in associated risk or even full recovery from diabetes. The procedures involved can either make use of specific apparatus or even altering of the digestive organs.

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Follows five basic rules:

Rule One: Eat Your Target Protein Every Day

By consuming the minimum amount of protein for your body, you maintain energy, muscle mass, and keep your hunger in check.Rule Two: Take Your Supplements Every Day
The daily nutritional supplements we prescribe to you will have a positive effect on your long-term health, energy, and longevity. Rule Three: Drink Water Every Day
As your body burns calories, waste products are released through urine. Drinking at least 64 ounces of water daily helps release these waste products so they don’t build up and slow your metabolism.Rule Four: Continue an Exercise Program
Getting the right amount of exercise is an essential part of successful long-term weight control and total well-being. Rule Five: Be Consistent with Your Diet
If you stick to your daily eating prescription and keep your caloric intake consistent from day to day, you increase your chances of maintaining your optimal weightGet your Maintenance Diet Plan today contact our resident Dietitian:Judy Kotze - Dietitian Special interest: Bariatric Nutrition BSc (Dietetics) - Diploma in Hospital Dietetics M (Nutrition) Durbanville Medi-Clinic Tel: 27-21 975 2336 Fax 27-21 9752692 Mobile: 083 254 0919

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Key Lifestyle Changes with Weight Loss Surgery

Some of the most important lifestyle changes to adapt to after weight loss surgery include:

* Slowly increasing physical activity
* Assessing and logging in daily food intake
* Undergoing counseling to adapt to the changing body image
* Eliminating social situations that promote overeating
* Tackling any emotional issues that triggered overeating with a therapist
* Making time to prepare special foods and meals to complement a healthier lifestyle